(The Patient Centered Medical Home continued) the practice has level One PCmH accreditation, $3.00 for level Two, and $3.50 for level Three. 2. PAyMENT FoR SERvICES INTEGRAL To PCMH CARE: Recently, Cms finalized a rule that will pay for chronic care management services, effective 2014. Practices can be paid for such services in addition to payment for evaluation/management (e/m)-based visits if they meet the following criteria: • Provide 24/7 access for care related to acute needs for chronic conditions • Provide continuity of care with a member of the care team • Develop and implement a care plan that includes a problem list, expected outcome and prognosis, measurable treatment goals, symptom management, planned interventions, medication management, community/ social services coordination, individuals responsible for interventions, and periodic review and update • management of transitions • Coordination with other providers • Provisions for non-visit-based access by patients Other payors may have similar payment arrangements in place and often follow medicare’s lead in what they will cover. 3. PAyMENT FoR PERFoRMANCE: One mechanism for this is through accountable Care Organizations (aCOs) or related models. success in such models depends on the access and care coordination that are key features of PCmHs. Reimbursement in such models can be primarily based on savings that they produce. another mechanism is payment based on results of quality measures. The most widely used measures are of primary care process and outcomes: preventive services, adherence to diagnostic testing, and clinical parameters (blood pressure, lipid, and diabetic control). Performance on such measures is a key objective of PCmH care. many commercial payors and state medicaid programs have performance-based payment incentives. additionally, as a result of the affordable Care act, medicare has been mandated to implement a Physician Value-Based multiplier that will result in 16 HBma BIllIng • maRCH.aPRIl.2014
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